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Helminths:Trematoda - non-segmented flat wormsg

The schistosomes:Schistosoma mansoniSchistosoma haematobiumSchistosoma japonic mSchistosoma japonicum Schistosoma mekongi

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Japan is schistosome-free as of 1976

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Aquatic freshwater snails are the intermediate hosts for all schistosome

speciesspecies

Schistosoma mansoni

Schistosoma japonicum

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Adult male and female Schistosoma mansoni

One Effective Evolutionary Strategy for Survival:Camouflage

Decorated Crab

Praying Mantis Sargasso Sea Horse

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bloodstreamavoiding immune attack by employing a unique set of

molecularmechanisms. One scheme involves incorporating host

serum proteins onto the tegumental surface as camouflage, mimicking

the strategy of the decorated crab. The other employs a mimic

f l l i il b 2 i l bl lisurface molecule similar to beta -2-microgloblulin, amacrophage recognition factor.

Possible applicationPossible application: transplant heterologous tissues at will.

Locked in life’s embrace

malemale

femalefemale

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Schistosoma mansoni in situ

Mesenteric veinWorm pairs

Mesenteric vein

Cross section of a pair of adult schistosomes in situ in a mesenteric venule

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Embryonated egg of Schistosoma mansoni*

Lateral spineLateral spine

Miracidium (larva)

40 μm

* The adult female requires tumor necrosis factor for maximum egg production

Embryonated egg of Schistosoma japonicum

Miracidium

Inapparent spine

20 μm

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Embryonated egg of Schistosoma mekongi

Miracidium

15 μm

Embryonated egg of Schistosoma haematobium

Miracidium

Terminal spine

20 μm

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Biomphilaria glabrata, a common intermediate snail host

for Schistosoma mansoni

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Miracidium of Schistosoma mansonicaught in the act of hatching

Miracidium of Schistosoma mansoni

Head

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SEM of a cercaria of Schistosoma mansoni,the infective stage for humans

Photo: D. Scharf

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Oncomelania nosophora, a common snail intermediate host for Schistosoma japonicum

in China

1 cm

Pathogenesis:

1. Miracidium inside egg in small intestine releases proteases, dissolves tissues, induces bleeding and diarrhea.

2 Eggs (50% of those produced) wash back into liver lodge in pre2. Eggs (50% of those produced) wash back into liver, lodge in pre-sinusoidal capillaries, eventually block flow of blood.

3. Blockage of portal circulation results in portal hypertension.

4. Portal hypertension leads to induction of embryonic circulatory paths, eggs then by-pass liver. Toxic brain syndrome may ensue.

5. Adults avoid immune detection by:5. Adults avoid immune detection by: a. camouflage strategy, incorporating host serum proteins on

tegumental surface.b. synthesizing β-2 microglobulin-like molecule on tegumental

surface.

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Clinical Disease:Acute Phase

1.“Katayama Fever”2. Paralysisy3. CNS involvement

Chronic Phase1. GI bleeding and diarrhea2. Portal hypertension due to blockage of pre-sinusoidal capillaries3 Esophageal varices3. Esophageal varices4. Ascites 5. Rupture of varices, bleeding, death6. Cor pulmonale, right side heart failure, death7. Toxic brain syndrome

Schistosome egg in tissue of the small intestine. Note intense granuloma

Egg

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Pipe stem fibrosis in liver due to heavy infection with Schistosoma mansoni.

Note normal liver tissue next to fibrotic vessels

Granuloma in liver surrounding eggs of Schistosoma mansoni

Lateral spine

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Granuloma surrounding an egg of Schistosoma mansoni in liver tissue

Diagnosis:

1 Microscopic examination of feces urine1. Microscopic examination of feces, urine, rectal “snip” for eggs.

2. Capture ELISA for detecting circulating antigens (experimental).

3. Serological tests (e.g., ELISA): indirect measure of exposure, not active disease.

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Summary of Schistosome Egg Morphology

Schistosoma mansoni Schistosoma japonicum

Schistosoma haematobium Schistosoma mekongi

75 μm 30 μm

Biopsy of rectal tissue revealing eggs of Schistosoma mansoni

Calcified eggindicates chronic Infection.

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Drug of Choice:Praziquantel

N

N

O

CO

N

N

O

CO

Mode of Action:Interferes with Ca2+ ion channels, leads to disrupted tegument. This drug is more effective if the patient has already developed antibodies against tegumental antigens.

Schistosoma haematobium

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Histological section of bladder with pseudopolyp due to chronic infection with Schistosoma

haematobium

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Schistosoma haematobium eggs in bladder wall

Terminal spine

Pathogenesis:g

Eggs lodge in bladder wall, induce cellular

changes associated with granuloma formation.

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Clinical Disease:

1. Squamous cell epithelioma

2. Calcification of dome of bladderdue to accumulation of dead eggs

3. Hydronephrosis

“Swimmer’s Itch”

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Cercaria of Schistosoma mansoniin skin surrounded by eosinophils

Cercaria

Eosinophils

Eosinophils and specific IgE antibodies combine to kill the parasiTh2 protective mechanism:

Medical Ecology:Transmission is encouraged by:

1. Dam building, irrigation projects (e.g., 3 Gorges Dam, China).

2. Reservoir hosts (primates, oxen).

3 Indiscriminate dispersal of feces and rine3. Indiscriminate dispersal of feces and urine into environment.

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Prevention and Control:1. Sanitary disposal of feces

Prevention and Control (cont’d)2 P bli h lth d ti2. Public health education.

3. Snail control.

4. Community-based drug programs (praziquantel)(praziquantel).

5. Vaccine development for reservoir hosts (e.g., water buffalo).

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One picture is…….